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Form HA-4632 Claimant's Medications
Claimant's Medications
HA-4632 - Revised Version
Claimant's Medication - PDF/Paper Version
OMB: 0960-0289
OMB.report
SSA
OMB 0960-0289
ICR 201502-0960-004
IC 43700
Form HA-4632 Claimant's Medications
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0960-0289 can be found here:
2021-11-02 - Revision of a currently approved collection
2018-07-26 - Revision of a currently approved collection
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File Modified
2015-03-16
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0000-01-01
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